This comic is a reference to the breast cancer surgery that Randall's fiancee/wife underwent. This comic is the follow up appointment after the surgery. When the doctor asks Megan to take her shirt off, she refuses until the doctor gives her a necklace of beads that, in the New OrleansMardi Gras culture, is used to exchange for the exposure of a female's breasts.

So, by Megan saying "You know the rules", that indicates that Megan has stipulated that every time she takes off her shirt for the doctor, a necklace of beads must be exchanged.

At the top of the comic page there is a link to a blog posting that talked about the real world events leading up to this comic.

The title text refers to a mastectomy, the surgical removal of one or both breasts. One possible treatment for breast cancer is to surgically remove the breast. After this procedure a false or prosthetic breast is often added to retain a normal physical appearance. The title text also suggests some things that could be concealed in this prosthesis. In the case a charging station with a USB port where the nipple would normally be, and lights to show how much charge the battery inside arranged around the darker circle of skin around the nipple.

Discussion

Commenter VaguelyCreepy had a few notes on Mardi Gras beads that are probably good to keep close to this page:

A few notes on the Mardi Gras beads:

They come in all colors, so pink isn’t particularly unusualy, though it could still fit if the doctor specifically chose that color for that reason.

New Orleans natives really frown on that kind of behavior, and you usually only see it from tourists who think Mardi Gras is some kind of excuse to do whatever you like. The entire thing is a celebration, but if you act like an ass, people are going to hate you for it, and you may very well get arrested. Also, the beads, as well as a variety of other memorabilia, are thrown to everyone, including the women who keep their tops on.

I have an app which identifies them as pink (I'm colorblind, so I can't personally pass judgement). The pink beads would definitely make sense. 108.162.219.202 06:33, 30 December 2013 (UTC)

I'm no expert, but if you open the image in Paint, zoom and use the eye-dropper, the color is definitely purple to the eye. My sample was (R,G,B => 175,68,173). It is not uniform, but other samples were similar. 108.162.219.223 22:49, 21 January 2014 (UTC)

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